Monday, January 4, 2010

London Drugs is a major pharmacy retailer with 73 stores located throughout Western Canada. Of their large team of pharmacists, a number receive specialized training to attain the designation of Patient Care Pharmacist (PCP). PCPs use their knowledge and skills to provide additional services such as health clinics covering a variety of topics such as heart health, osteoporosis, diabetes, asthma, smoking cessation, and sun care. All clinics include customer assessment and education. Assessments are frequently aided with medical devices such as a blood pressure monitor or blood cholesterol meter for heart health, or a bone densitometer for osteoporosis clinics. Outputs from the device and information gathered during the health interview enable PCPs and customers to have a meaningful health conversation.

Ongoing customer interest in nutrition issues, particularly weight loss, prompted an exploration of a suitable clinic. I was part of a team of registered dietitians, pharmacists, a medical doctor, and marketing personnel tasked with creating this new clinic. We decided that weight loss per se was too complex a health challenge to adequately tackle and wanted to take a healthy lifestyle approach instead. With this in mind, we determined that body composition analysis would be a suitable assessment tool. We selected a stand-on scale that provided weight, body mass index (BMI), estimated caloric expenditure, body fat, and body muscle. Our team became familiar with the device, its technical outputs, health-related meanings, and its limitations. We felt we could tie aspects of body composition to useful nutrition interventions. We then determined eligibility criteria so as to recruit appropriate customers (i.e., adults with normal/ minimal health issues.) Customers were to be referred to local outpatient or consulting dietitians if their concerns were beyond the scope of the clinic.

We developed a training program for the PCPs that included how to set up and use the device, how to conduct a basic nutrition assessment, and how to help customers set healthy lifestyle goals. The nutrition assessment was based on a specially designed customer diet history form. PCPs were trained to scrutinize the history for meal frequency, adequacy of food groups, and use of high calorie beverages and “other” foods. PCPs were also trained to deliver nutrition messages using Canada’s Food Guide, the “plate method” of healthy eating, and other straightforward, actionable tools. Physical activity was promoted as well. Educational resources were gathered from Health Canada, the Dairy Farmers of Canada, the Heart and Stroke Foundation, and other respected sources.

The clinics were offered over the spring and summer, 2009. Analysis of clinic consultations revealed that customer encounters generally lasted 45 minutes and included body composition analysis, explanation of results, discussion of the diet history, trouble shooting, and goal setting. Follow-up visits were conducted six months after the initial visit. The clinics were well received by customers and PCPs alike. Many found the body composition analysis to be quite revealing and others found the lifestyle assessment an excellent starting point for discussion and goal setting. The PCPs enjoyed delivering the clinics and being able to convey a new health message within their scope of practice. The follow-up visit allowed PCPs to develop rapport with customers and provided positive reinforcement regarding his/ her individual goals.

This interprofessional collaboration created an opportunity for me, a dietitian, to work closely with other health care providers. I was particularly fortunate to learn much more about community pharmacists, their roles, work settings, and scope of practice. Likewise, the pharmacists got to learn about and work with dietitians, a new experience for many of them. Together we determined the appropriate areas of nutrition assessment and education to add to the PCPs previous strengths. This collaboration allowed the creation of a clinic that was custom-made for pharmacists to deliver.

We were pleased to have created a unique service in a unique setting (retail pharmacy) that raised the nutrition knowledge of pharmacists and their customers. The service also raised awareness of nutrition education materials and resources (such as Dial-a-Dietitian and Eat Right Ontario), and promoted the registered dietitian as the expert for more challenging nutrition concerns. Thus, while customer demand for “weight loss” drove the creation of the clinic, we chose to meet that demand with a more holistic message of healthy eating and physical activity.

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Practice includes information on scientific and clinical developments and Canadian dietitians’ experiences and challenges in practice. Opinions expressed in articles are those of the authors and do not imply policy of the Association unless so stated. Articles are not peer-reviewed.